Free Markets, Free People

Policy

A Closer Look At European Health Care

We continue to hear how wonderful it is as compared to the horrible US system.

But is it? One of the fundamental truths of any health care system is you have infinite demand meeting finite resources (beds, doctors, availability, etc). Whatever system a country has, that truth doesn’t change.

So, regardless of system, there is going to be some sort of rationing. It is unavoidable and inevitable.

Now add a desire to control and cut costs associated with the provision of health care to the mix (the promise of every one of these government systems). On the one side, as European nations have done, access to health care is expanded to include everyone. On the other hand, these same nations attempt to control health care costs.

The result? Very mixed. France is always held up as the exception to the rule that government health care can’t be both good and inexpensive. But a closer examination seems to indicate that it isn’t an exception at all:

A World Health Organization survey in 2000 found that France had the world’s best health system. But that has come at a high price; health budgets have been in the red since 1988.

In 1996, France introduced targets for health insurance spending. But a decade later, the deficit had doubled to 49 billion euros ($69 billion).

“I would warn Americans that once the government gets its nose into health care, it’s hard to stop the dangerous effects later,” said Valentin Petkantchin, of the Institut Economique Molinari in France. He said many private providers have been pushed out, forcing a dependence on an overstretched public system.

Why have private providers been “pushed out”? Because government has provided health care “cheaper” than do private providers (and obviously at a loss given the deficit). Notice I said “cheaper”. That doesn’t necessarily mean “better”.

And the same thing is being seen in other European health care systems which are considered “models” of government run health care:

Similar scenarios have been unfolding in the Netherlands and Switzerland, where everyone must buy health insurance.

“The minute you make health insurance mandatory, people start overusing it,” said Dr. Alphonse Crespo, an orthopedic surgeon and research director at Switzerland’s Institut Constant de Rebecque. “If I have a cold, I might go see a doctor because I am already paying a health insurance premium.”

Cost-cutting has also hit Switzerland. The numbers of beds have dropped, hospitals have merged, and specialist care has become harder to find. A 2007 survey found that in some hospitals in Geneva and Lausanne, the rates of medical mistakes had jumped by up to 40 percent. Long ranked among the world’s top four health systems, Switzerland dropped to 8th place in a Europe-wide survey last year.

Dr. Crespo’s point is simply an astute observation of human nature. If something doesn’t directly cost the user, why would the user ration the use of such a benefit?

The use, however, still costs someone or something. The doctor must be paid, the institution must be paid, etc. So in the end, the only way to control costs is to cut payments. Eventually, the incentives to enter the health care field become less attractive (unless you like long hours, overrun waiting rooms, minimal time with patients, being second-guessed by a bureaucracy and making much less than a private system allows for compensation) and there are fewer that enter the field. Hospital beds then drop, hospitals merge and there are fewer specialists available to serve the population as Switzerland is discovering.

And then there’s the lack of innovation to face.

Bureaucracies are slow to adopt new medical technologies. In Britain and Germany, even after new drugs are approved, access to them is complicated because independent agencies must decide if they are worth buying.

When the breast cancer drug Herceptin was proven to be effective in 1998, it was available almost immediately in the U.S. But it took another four years for the U.K. to start buying it for British breast cancer patients.

The promise that has been made in the US is health care reform will return the decision making to the doctor. But that’s simply a false promise given the priorities of the reform we’ve been promised. It is to cut cost and make care “affordable” to all. Somewhere is a bureaucracy in waiting which will decide what “affordable” means – and it won’t include your doctor.

So you can expect innovation to begin to slow. Why invest billions when a bureaucracy will decide whether or not it’s a medicine or treatment worth the cost. The same bureaucracy will also decide what it will pay for your innovation. Of course, if the innovator can’t recover the cost of development and make a profit as incentive toward more innovation, the probability exits the developer will simply stop such research.

“Government control of health care is not a panacea,” said Philip Stevens, of International Policy Network, a London think-tank. “The U.S. health system is a bit of a mess, but based on what’s happened in some countries in Europe, I’d be nervous about recommending more government involvement.”

Words of wisdom most likely to be ignored by our legislators here. And the unfortunate thing is it will not only destroy an excellent health care system here, but, given the level of government spending forecast, tank the rest of the economy as well.

~McQ

[HT: Carol D]

So What Could Cap-and-Trade Eventually Bring?

Well if the UK is any example, “green jackets”, a sort of environmental police force with the power to enter and search (with a blanket “warrant”) any company it so chooses to inspect. Is “Gestapo-like” tactics a stretch?

The boys in green are coming as the Environment Agency sets up a squad to police companies generating excessive CO2 emissions.

The agency is creating a unit of about 50 auditors and inspectors, complete with warrant cards and the power to search company premises to enforce the Carbon Reduction Commitment (CRC), which comes into effect next year.

Decked out in green jackets, the enforcers will be able to demand access to company property, view power meters, call up electricity and gas bills and examine carbon-trading records for an estimated 6,000 British businesses. Ed Mitchell, head of business performance and regulation at the Environment Agency, said the squad would help to bring emissions under control. “Climate change and CO2 are the world’s biggest issues right now. The Carbon Reduction Commitment is one of the ways in which Britain is responding.”

The formation of the green police overcomes a psychological hurdle in the battle against climate change. Ministers have long recognised the need to have new categories of taxes and criminal offences for CO2 emissions, but fear a repetition of the fuel tax protests in 2000 when lorry drivers blockaded refineries.

Criminal offenses for “CO2 emissions” – Orwell saw this coming but clearly he didn’t understand that it would be based in criminalizing a natural byproduct of respiration and trace atmospheric gas, did he?

Again, it’s the precedent this sets which is both upsetting and dangerous. Probable cause? Green Jackets don’t need no probable cause!

Let freedom ring.

~McQ

Happy “Dependence” Day

I‘m sorry, but the more I get into the monstrosities coming out of Washington DC, the less I see “independence” as a reality. Just a quick read through Waxman-Markey (and a quick read in anything but easy given the size of the bill) will tend to make you a bit pessimistic about “independence”. Consider the mundane topic of shade trees:

SEC. 205. TREE PLANTING PROGRAMS.

(a) Findings- The Congress finds that–

(1) the utility sector is the largest single source of greenhouse gas emissions in the United States today, producing approximately one-third of the country’s emissions;

(2) heating and cooling homes accounts for nearly 60 percent of residential electricity usage in the United States;

(3) shade trees planted in strategic locations can reduce residential cooling costs by as much as 30 percent;

(4) shade trees have significant clean-air benefits associated with them;

(5) every 100 healthy large trees removes about 300 pounds of air pollution (including particulate matter and ozone) and about 15 tons of carbon dioxide from the air each year;

(6) tree cover on private property and on newly-developed land has declined since the 1970s, even while emissions from transportation and industry have been rising; and

(7) in over a dozen test cities across the United States, increasing urban tree cover has generated between two and five dollars in savings for every dollar invested in such tree planting.

So now the federal government will issue guidelines and hire experts to ensure you plant shade trees properly:

(4) The term ‘tree-siting guidelines’ means a comprehensive list of science-based measurements outlining the species and minimum distance required between trees planted pursuant to this section, in addition to the minimum required distance to be maintained between such trees and–

(A) building foundations;

(B) air conditioning units;

(C) driveways and walkways;

(D) property fences;

(E) preexisting utility infrastructure;

(F) septic systems;

(G) swimming pools; and

(H) other infrastructure as deemed appropriate

And Waxman-Markey is indeed a “green-job creator” of a bill – it creates an entirely new job category – Federal House Inspector. Yes, that’s right, in order to sell your house in the future you must passed a federal housing inspection which will certify your home has the minimal energy rating necessary. And if not, you’ll be required to bring it up to par by replacing appliances (water heaters, air conditioning, etc) or repairing (leaky windows, etc) whatever the inspector finds before you can put it on the market.

Have a candelabra in your dining room? Don’t you dare put any more than a 60 watt bulb in there.  You need to also bone up on what you’ll be allowed to do with outdoor lighting, water dispensers, hot tubs and other appliances, not to mention wood burning stoves and water usage.

Yup, if this piece of legislation makes it through the Senate, we need to seriously rethink the name we give the 4th of July. “Independence” will no longer apply. And, given the level of intrusion this bill brings to our lives, you can just imagine what’s in store for us in any health care legislation passed by this administration.

Happy Dependence Day, folks.

~McQ

Climate Change Update – Falling Dominoes

For the American taxpayer, under the shadow of the recently passed House cap-and-trade (Waxman-Markey) bill, the news continues to be grim. However for the traitorous “deniers”, aka skeptics, who believe the whole climate change hysteria to be an economy killing farce, things are looking better.

For instance India has announced it will not participate in the Western world’s attempts to kill their own economies:

India said it will reject any new treaty to limit global warming that makes the country reduce greenhouse-gas emissions because that will undermine its energy consumption, transportation and food security.

Cutting back on climate-warming gases is a measure that instead must be taken by industrialized countries, and India is mobilizing developing nations to push that case, Environment Minister Jairam Ramesh told the media today in New Delhi.

“India will not accept any emission-reduction target — period,” Ramesh said. “This is a non-negotiable stand.”

Heh … fairly blunt and straight foward wouldn’t you say? Of course, China took the same stand a couple of weeks ago. I call that good news because it is another country which has decided to put its economy first and this nonsense second. When two countries which are or expected to be very soon the two leading emitters of CO2 say “no”, it makes it rather ridiculous for the rest of the world to say “yes” given the consequences vs. payoff, doesn’t it?

And the US cap-and-trade legislation? Well India sees that as a “no-go” as well:

But last week, the US House of Representatives backed a “border adjustment tax” to equalise carbon emissions charges between domestic production and imports from states that do not cap emissions. The legislation is likely to face tough opposition in the Senate.

Mr Ramesh denounced as “pernicious” US efforts to impose “trade penalties” on countries that do not match its carbon reduction moves.

Meanwhile in the EU:

The European Union risks driving industry out of the region if it continues to push for deeper cuts in carbon dioxide emissions than other economies, according to the chief executive of Eon, one of the world’s biggest renewable energy companies.

Wulf Bernotat, Eon’s chief executive, told the Financial Times that the EU was imposing higher energy costs on its industry than competing regions, and criticised the US for doing “basically nothing” to cut its carbon dioxide emissions.

He added that if there were no international deal to cut emissions agreed at the Copenhagen meeting at the end of the year, the EU would have to rethink its plans to take a lead in fighting the threat of climate change.

“It is a European political issue whether the European Union can continue to lead the policy process if the rest of the world is not joining in,” he said.

“We are adding additional costs to our industries, and if other countries don’t follow, then those industries will move to lower-cost regions.”

Yeah, like India or China … or Mexico. That’s the irony of this nonsense. We have a president and Congress who’ve made a cottage industry of demonizing corporations who “outsource” jobs while they pass legislation that encourages corporations to outsource jobs.

And for those who worship at the feet of Al Gore, another inconvenient truth is to be found in a recently published paper from the Journal of Atmospheric and Solar-Terrestrial Physics:

The Abstract states:

Daily temperature and pressure series from 55 European meteorological stations covering the 20th century are analyzed. The overall temperature mean displays a sharp minimum near 1940 and a step-like jump near 1987. We evaluate the evolution of disturbances of these series using mean squared inter-annual variations and “lifetimes”. The decadal to secular evolutions of solar activity and temperature disturbances display similar signatures over the 20th century. Because of heterogeneity of the climate system response to solar forcing, regional and seasonal approaches are key to successful identification of these signatures. Most of the solar response is governed by the winter months, as best seen near the Atlantic Ocean. Intensities of disturbances vary by factors in excess of 2, underlining a role for the Sun as a significant forcing factor of European atmospheric variations. We speculate about the possible origin of these solar signatures. The last figure of the paper exemplifies its main results.

The paper concludes:

In concluding, we find increasingly strong evidence of a clear solar signature in a number of climatic indicators in Europe, strengthening the earlier conclusions of a study that included stations from the United States (Le Mouël et al., 2008). With the recent downturn of both solar activity and global temperatures, the debated correlations we suggested in Le Mouël et al. (2005), which appeared to stop in the 1980s, actually might extend to the present. The role of the Sun in global and regional climate change should be re-assessed and reasonable physical mechanisms are in sight.

Shorter conclusion?

“It’s the sun, stupid”.

~McQ

CBO, Entitlments, Health Care Reform and the Deficit

One more time into the breach. The CBO has issued a warning to Congress about entitlement spending. Again. Here’s a key paragraph:

Almost all of the projected growth in federal spending other than interest payments on the debt comes from growth in spending on the three largest entitlement programs–Medicare, Medicaid, and Social Security.

Most of you know that Medicare and Medicaid have an unfunded future liability of 36 trillion dollars. That’s about 3 times the annual total GDP of the US economy. And they are the very same type of “public option” program – i.e. government insurance – that the left says is so very necessary and crucial to real “health care reform”.

In other words, the left’s argument is that adding at least 47 million (presently uninsured), plus the possibility of adding 119 million who are shifted to the public option from private insurance (private insurance, btw, doesn’t have any effect on the deficit whatsoever since we, the private sector, are paying for it) will somehow make the deficit picture better?

I’m obviously missing something here.

With the public option, we’re adding a new entitlement (47 million who presently supposedly can’t afford insurance, meaning taxpayers will subsidize theirs). Assuming it is set up originally to be paid for by premiums, at some point, like Medicare and Medicaid, and every other government entitlement program I can think of, it will pay out more than it takes in. How can it not? It is a stated “non-profit” program and it will include subsidies. At some point, another revenue stream is going to be necessary as it burns through the premiums with its payouts.

Well, say the proponents of government involvement in your health care, we’re going to save money by doing preventive health care. Yes, preventive care is the key to lower costs because a healthier population is one which visits the doctor less. While that may seem to be at least partially true (you’d think a healthier population would, logically, visit the doctor less) the part that is apparently missed when touting this popular panacea is the cost of making the population healthier (and the fact that the assumption of less visits isn’t necessarily true) doesn’t cost less – it costs more:

If health care providers can prevent or delay conditions like heart disease and diabetes, the logic goes, the nation won’t have to pay for so many expensive hospital procedures.

The problem, as lawmakers are discovering to their frustration, is that the logic is wrong. Preventive care — at least the sort delivered by doctors — doesn’t save money, experts say. It costs money.

That’s old news to the analysts at the Congressional Budget Office, who have told senators on the Health, Education, Labor and Pensions Committee that it cannot score most preventive-care proposals as saving money.

So with that myth blown to hell, we’re now looking at a government plan which will add cost to the deficit by subsidizing the insurance of 47 million and (most likely) many more, plus a plan to use a more costly form of medicine as its primary means of giving care.

But, back to the entitlement report – or warning. The CBO says that unless entitlements are drastically reformed (that means Medicare, Medicaid and to a lesser extent, Social Security) we’re in deep deficit doodoo:

The most frightening findings in this report are the deficit and debt projections. In this year and next year, the yearly budget shortfall, or deficit, will be the largest post-war deficits on record–exceeding 11 percent of the economy or gross domestic product (GDP)–and by 2080 it will reach 17.8 percent of GDP.

The national debt, which is the sum of all past deficits, will escalate even faster. Since 1962, debt has averaged 36 percent of GDP, but it will reach 60 percent, nearly double the average, by next year and will exceed 100 percent of the economy by 2042. Put another way, in about 30 years, for every $1 each American citizen and business earns or produces, the government will be an equivalent $1 in debt. By 2083, debt figures will surpass an astounding 306 percent of GDP.

The report also finds high overall growth in the government as a share of the economy and of taxpayers’ wallets that provides an additional area of concern. While total government spending has hovered around 20 percent of the economy since the 1960s, it has jumped by a quarter to 25 percent in 2009 alone and will exceed 32 percent by 2083. Taxes, which have averaged at 18.3 percent of GDP, will reach unprecedented levels of 26 percent by 2083. Never in American history have spending and tax levels been that high.

Here’s the important point to be made – these projections do not include cap-and-trade or health care reform.

Got that? We’re looking at the “highest spending and tax levels” in our history without either of those huge tax and spend programs now being considered included in the numbers above. Total government spending, as a percent of GDP is now at an unprecedented 25%. And they’re trying to add more while this president, who is right in the middle of it, tells us we can’t keep this deficit spending up forever.

Fair warning.

~McQ

Krugman Endorses “Carbon Tariff”

Paul Krugman came out today for “border adjustments” (tariffs) on goods from countries who aren’t participating in economy killing CO2 emissions control taxation.

His argument:

If you only impose restrictions on greenhouse gas emissions from domestic sources, you give consumers no incentive to avoid purchasing products that cause emissions in other countries; as a result, you have an inefficient outcome even from a world point of view. So border adjustments here are entirely legitimate in terms of basic economics.

Actually they’re “entirely legitimate” if you swallow the premise Krugman is pushing here, namely that CO2 is a “pollutant” and its restriction is a “legitimate” reason for imposing taxes on both your own economy and the goods coming from another economy which doesn’t agree with the premise. And, of course, this ignores the probable reaction countries hit with this tariff might have.

Krugman then attempts to justify such a “border adjustment” by claiming such a move is probably legal under “international law”:

The WTO has looked at the issue, and suggests that carbon tariffs may be viewed the same way as border adjustments associated with value-added taxes. It has long been accepted that a VAT is essentially a sales tax — a tax on consumers — which for administrative reasons is collected from producers. Because it’s essentially a tax on consumers, it’s legal, and also economically efficient, to collect it on imported goods as well as domestic production; it’s a matter of leveling the playing field, not protectionism.

And the same would be true of carbon tariffs.

What he sort of dances around when he claims this will “level the playing field” is all products, regardless of their origin, will see dramatically increased pricing. The point of the tax is to hopefully steer consumers to domestically produced products which are produced under government approved conditions rather than those from countries like China and India which aren’t playing the game the US wants them to play. Not only will the consumer here be asked to pay for the CO2 offsets imposed on domestic industry, but they will have to pay for offsets for foreign producers as well when the VAT cost is passed on in the price of the goods.

The thinking, obviously, is that if prices are the same, US consumers will buy US goods instead of, say, Chinese goods. The problem, of course, is much of what we consume isn’t made here anymore. So the result would be the US consumer would end up paying higher prices for goods produced in China with no change in behavior by China.

Additionally, China will view this as a protectionist measure, whether the WTO thinks it is “legal” or not. China will simply claim that the US, as a rich country and large “polluter”, should be doing more than they are doing in terms of emissions control, and impose its own “WTO legal” VAT in response. Same with any other country targeted by the US for a tariff.

This is, frankly, an invitation to a trade war. Krugman can wrap his protectionist argument in whatever legality he’d like, but the fact remains most countries effected will view it as an attempt to limit trade and react accordingly. And, of course, by Krugman’s own admission, it is you who will be paying the tariff cost for China and India if this is ever passed into law.

~McQ

Obama’s Contradictory Foreign Policy

Melanie Phillips points to an interesting contradiction:

As the world watched events unfold in Iran, Obama’s double standard over Israel was illuminated in flashing neon lights. How come he’s saying it is wrong for him to tell the Iranians what to do, people asked themselves, when he is dictating to Israel its policy on settlements?

It’s an excellent question. So what is the policy of the United States qua Barack Obama – strict hands off concerning the “internal affairs” of a country, or, in the case of Israel, what can only be considered “meddling” in internal affairs?

Just wondering …

~McQ

No Hot Dogs For Iran

It took almost two weeks of brutalizing their own people, but the invitation for Iranian diplomats to attend Fourth of July parties at U.S. Embassies around the world has finally been rescinded. Of course this was done about a day after President Obama gave this mealy-mouthed answer to a question on the subject:

Q: Are Iranian diplomats still welcome at the embassy on the Fourth of July, sir?

THE PRESIDENT: Well, I think as you’re aware, Major, we don’t have formal diplomatic relations with — we don’t have formal diplomatic relations with Iran. I think that we have said that if Iran chooses a path that abides by international norms and principles, then we are interested in healing some of the wounds of 30 years, in terms of U.S.-Iranian relations. But that is a choice that the Iranians are going to have to make.

For those of you who need a translator, the answer was “yes”. Today the answer is “no”.

I’m glad they’ve awakened up there to the reality of what is happening in Iran and finally made some sort of move, no matter how trivial or symbolic, to show their disapproval. But it has taken unrelenting pressure to get them to move off of their “engagement at any cost” policy.  In the case of 4th of July celebrations, it would have been a travesty to have representatives of the present brutal regime present.  Ed Morrissey asks what they’d have been present for anyway:

Besides, what Independence Day values would the Iranian regime want to celebrate with us? Freedom of speech? Freedom of religion? The freedom to peaceably assemble or petition government for a redress of grievances?

Obama rather arrogantly reminded us that “only I am President of the United States”. But as former Secretary of State Lawrence Eagleburger reminded Obama, that means he represents the people of the United States when he speaks and in the case of the Iranian violence, he hasn’t represented them very well at all.

~McQ

The “Bullet Fee”

Shades of the Chicoms and Saddam Hussein.

A protester is shot dead in Iran. His father learns of his death:

Upon learning of his son’s death, the elder Mr. Alipour was told the family had to pay an equivalent of $3,000 as a “bullet fee”—a fee for the bullet used by security forces—before taking the body back, relatives said.

But we don’t want to be the “foil” so we’ll withold saying anything that might be misinterpreted. Well, except this:

But privately Obama advisers are crediting his Cairo speech for inspiring the protesters, especially the young ones, who are now posing the most direct challenge to the republic’s Islamic authority in its 30-year history.

Ed Morrisey calls this “despicable”. I say he’s being very understated in his criticism.

Pass the hot dogs.

Please.

~McQ

Questions And Observations

Some conversation starters:

  • For new readers, the title is what the shortened “QandO” means.
  • I’m constantly amused by the anecdotal evidence I gather while on the road that says if you’re over 65 you have to drive a Buick.
  • One thing to keep in mind as you listen to all of these proponents tell you that government can do health care better than the private sector – The private sector is a net producer of wealth. The government sector is a net consumer of wealth. That’s why the more of the economy a government takes over the less wealth is produced and thus available within the economy.
  • Interesting chart showing the level of spending in the last 12 months compared to the spending over the last 206 years in inflation adjusted dollars.  How do people believe that such a massive increase in spending doesnt have to be paid for at some point?
  • Is Obama’s honeymoon over?  Is enough resistance building to derail some of these economy killing policies and programs now on the table?
  • Former President Bush speaks out, apparently tired of a president 150 days into his own administration continuing to blame the previous administration. Appropriate or should he remain silent? And interestingly, since the left excused Jimmy Carter’s criticism of the Bush administration, does that mean they’re fine with Bush speaking out?
  • Is it “IGgate”? What’s up with this story about the Americorps IG and are there more IGs with whom the administration has messed? Wasn’t this the administration which was going to “return” us to the “rule of law”? Why aren’t they following it?

~McQ